The "central vein sign" in patients with diagnostic "red flags" for multiple sclerosis: A prospective multicenter 3T study.
Central vein sign
MS diagnosis
red flags
Journal
Multiple sclerosis (Houndmills, Basingstoke, England)
ISSN: 1477-0970
Titre abrégé: Mult Scler
Pays: England
ID NLM: 9509185
Informations de publication
Date de publication:
04 2020
04 2020
Historique:
pubmed:
20
9
2019
medline:
8
5
2021
entrez:
20
9
2019
Statut:
ppublish
Résumé
The central vein sign (CVS) has been shown to help in the differential diagnosis of multiple sclerosis (MS), but most prior studies are retrospective. To prospectively assess the diagnostic predictive value of the CVS in diagnostically difficult cases. In this prospective multicenter study, 51 patients with suspected MS who had clinical, imaging, or laboratory "red flags" (i.e. features atypical for MS) underwent 3T fluid-attenuated inversion recovery (FLAIR*) magnetic resonance imaging (MRI) for CVS assessment. After the diagnostic work-up, expert clinicians blinded to the results of the CVS assessment came to a clinical diagnosis. The value of the CVS to prospectively predict an MS diagnosis was assessed. Of the 39 patients who received a clinical diagnosis by the end of the study, 27 had MS and 12 received a non-MS diagnosis that included systemic lupus erythematosus, sarcoidosis, migraine, Sjögren disease, SPG4-spastic-paraparesis, neuromyelitis optica, and Susac syndrome. The percentage of perivenular lesions was higher in MS (median = 86%) compared to non-MS (median = 21%; The CVS detected on 3T FLAIR* images can accurately predict an MS diagnosis in patients suspected to have MS, but with atypical clinical, laboratory, and imaging features.
Sections du résumé
BACKGROUND
The central vein sign (CVS) has been shown to help in the differential diagnosis of multiple sclerosis (MS), but most prior studies are retrospective.
OBJECTIVES
To prospectively assess the diagnostic predictive value of the CVS in diagnostically difficult cases.
METHODS
In this prospective multicenter study, 51 patients with suspected MS who had clinical, imaging, or laboratory "red flags" (i.e. features atypical for MS) underwent 3T fluid-attenuated inversion recovery (FLAIR*) magnetic resonance imaging (MRI) for CVS assessment. After the diagnostic work-up, expert clinicians blinded to the results of the CVS assessment came to a clinical diagnosis. The value of the CVS to prospectively predict an MS diagnosis was assessed.
RESULTS
Of the 39 patients who received a clinical diagnosis by the end of the study, 27 had MS and 12 received a non-MS diagnosis that included systemic lupus erythematosus, sarcoidosis, migraine, Sjögren disease, SPG4-spastic-paraparesis, neuromyelitis optica, and Susac syndrome. The percentage of perivenular lesions was higher in MS (median = 86%) compared to non-MS (median = 21%;
CONCLUSION
The CVS detected on 3T FLAIR* images can accurately predict an MS diagnosis in patients suspected to have MS, but with atypical clinical, laboratory, and imaging features.
Identifiants
pubmed: 31536435
doi: 10.1177/1352458519876031
pmc: PMC7080603
mid: NIHMS1538252
doi:
Types de publication
Journal Article
Multicenter Study
Research Support, N.I.H., Intramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
421-432Subventions
Organisme : Intramural NIH HHS
ID : Z99 NS999999
Pays : United States
Commentaires et corrections
Type : CommentIn
Références
JAMA Neurol. 2018 Dec 1;75(12):1546-1553
pubmed: 30167654
Mult Scler. 2018 May;24(6):750-757
pubmed: 28820013
Ann Neurol. 2019 Jun;85(6):934-942
pubmed: 30847935
Ann Neurol. 2011 Feb;69(2):292-302
pubmed: 21387374
Arthritis Rheum. 2012 Aug;64(8):2677-86
pubmed: 22553077
Radiology. 2012 Dec;265(3):926-32
pubmed: 23074257
Neurology. 2018 Apr 3;90(14):e1183-e1190
pubmed: 29514948
J Neurol Neurosurg Psychiatry. 2016 Dec;87(12):1287-1295
pubmed: 28103199
Ann Neurol. 2018 Feb;83(2):283-294
pubmed: 29328521
Mult Scler. 2008 Nov;14(9):1157-74
pubmed: 18805839
N Engl J Med. 2018 Jan 11;378(2):169-180
pubmed: 29320652
Mult Scler. 2016 Sep;22(10):1289-96
pubmed: 26658816
Neurology. 2019 Jan 1;92(1):26-33
pubmed: 30381369
Lancet Neurol. 2018 Feb;17(2):162-173
pubmed: 29275977
Lancet Neurol. 2014 Jul;13(7):740-6
pubmed: 24943346
Neurology. 2015 Jul 14;85(2):177-89
pubmed: 26092914
Nat Rev Neurol. 2016 Dec;12(12):714-722
pubmed: 27834394
Nat Rev Neurol. 2017 Sep;13(9):567-572
pubmed: 28799551
JAMA Neurol. 2013 May;70(5):623-8
pubmed: 23529352
J Magn Reson Imaging. 2019 Sep;50(3):878-888
pubmed: 30652391
Neurol Clin Pract. 2019 Jun;9(3):218-227
pubmed: 31341709
Nat Rev Neurol. 2013 May;9(5):267-76
pubmed: 23528543
Lancet Neurol. 2006 Oct;5(10):841-52
pubmed: 16987731
Curr Neurol Neurosci Rep. 2015 Aug;15(8):57
pubmed: 26112766
Arthritis Rheumatol. 2017 Jan;69(1):35-45
pubmed: 27785888
JAMA Neurol. 2018 Nov 1;75(11):1392-1398
pubmed: 30083703
Ann Clin Transl Neurol. 2015 Dec 16;3(2):82-7
pubmed: 26900578
Mult Scler. 2012 Nov;18(11):1592-9
pubmed: 22711711
Nat Rev Neurol. 2018 Apr;14(4):199-213
pubmed: 29521337
Brain. 2019 Jul 1;142(7):1858-1875
pubmed: 31209474
Neurology. 2011 Feb 8;76(6):534-9
pubmed: 21300968